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[Laparoscopic cholecystectomy at an oncologic center: a comparative analysis]
L F Oñate-Ocaña1, R J Mondragón-Sánchez, J M Ruiz-Molina
1Departamento de Gastroenterología, Instituto Nacional de Cancerología, México, D.F.
Objective:
To analyze and compare our results with open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) in patients with cancer.
Design:
Case-control study.
Setting:
An oncologic referral center in Mexico City.
Patients:
All patients with previous treatment for cancer and indication for cholecystectomy who where referred in a 60-month period. They were divided into two groups. Group OC with operation performed in the former 30 months and group LC with operation performed in the later 30 months.
Results:
Lower morbidity and mortality rates and less hospital stay were found in group LC (55 cases) as compared with group OC (50 cases). Conversion rate in group LC was 14%. This rate is higher in patients with previous surgeries in upper abdomen. There were no differences in morbidity and mortality in patients with previous abdominal surgeries or with diabetes. Patients with liver cirrhosis in group OC had higher morbidity and mortality.
Conclusions:
LC can be performed safely in patients with history of cancer, laparotomy or abdominal radiation therapy and should be considered as first choice for symptomatic gallstones. LC should be considered also in diabetes and liver cirrhosis. When previous surgery in the upper abdomen is found we recommend to insert the first trocar under direct vision of peritoneal cavity. In this case conversion rate is high.